Sick Day Rules for Patients with Type 2 Diabetes

The 6 key tips for a patient with diabetes to avoid a diabetes crisis during illness are:

1. Follow up with your regular endocrinologist to maintain good glycaemic control with an HbA1c around 7%

2. If you fall ill, check your blood glucose regularly 5-6 times in a day to ensure it stays within a reasonable range (expect your blood glucose to run slightly higher than usual due to higher stress hormones during an acute illness)

3. Stay well hydrated (if you're vomiting and can't keep any fluids down, see a doctor)

4. Try to eat regular meals (if solid food is difficult, consider fluids like smoothies or milkshakes to ensure some caloric intake but watch your glucose levels)

5. Be prepared to make changes to your diabetes medications (if you aren't sure what to do - get in touch with your usual diabetes nurse educator to get advice on how to make adjustments or see your local GP to get advice)

6. If your blood sugar is persistently <4mmol/L or >20mmol/L, go to the emergency department or an acute care centre for urgent medical attention.

Why do I need to follow these sick day rules?

Without appropriate care and attention, blood sugar levels can go haywire during an acute illness and may lead to a diabetes crisis.

A diabetes crisis is an emergency - one of the types of diabetes crisis is called Hyperglycaemic Hyperosmolar Syndrome (HHS) and is more common in patients with Type 2 diabetes mellitus. Other types include diabetic ketoacidosis (DKA) or severe symptomatic hypoglycaemia which I'll talk about in my upcoming blog posts.

Hyperglycaemic hyperosmolar syndrome or HHS is a diabetes emergency that needs urgent attention as it can be fatal if left untreated. It can occur to anyone who has diabetes, but more commonly in patients with poor glycemic control. In HHS, patients can get severely dehydrated, confused, lethargic and may even demonstrate abnormal movements like seizures. It can be triggered by missed medication, a simple illness like a common cold, or more serious medical conditions like a stroke, sepsis or a heart attack.